HHS has finalized a rule requiring certain electronic healthcare claims and prior authorization transactions to include standardized electronic attachments.
The rule adopts new standards under HIPAA for electronic data exchange between providers and payers, aimed at reducing administrative burden, improving efficiency and supporting faster claims processing, according to a final rule published March 24 in the Federal Register. It applies to transactions that currently rely on manual processes to convey clinical information, such as medical charts or lab results.
The final rule estimates significant long-term savings for providers and payers, projecting up to $9 billion in net benefits over 10 years through reduced labor and document-handling costs. Compliance is required by Jan. 1, 2027, with a phased implementation beginning in 2026.
The rule does not apply to workers’ compensation, auto or property and casualty insurance plans.
CMS and the Office of the National Coordinator for Health Information Technology said the new standards will promote greater interoperability and align with broader efforts to streamline prior authorization and payment workflows across the healthcare system.
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